Zwan Marissa D, Bouwman Femke H, Konijnenberg Elles, van der Flier Wiesje M, Lammertsma Adriaan A, Verhey Frans R J, Aalten Pauline, van Berckel Bart N M, Scheltens Philip
Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands.
Alzheimers Res Ther. 2017 Jan 17;9(1):2. doi: 10.1186/s13195-016-0228-4.
Early-onset dementia patients often present with atypical clinical symptoms, hampering an accurate clinical diagnosis. The purpose of the present study was to assess the diagnostic impact of the amyloid-positron emission tomography (PET) imaging agent [F]flutemetamol in early-onset dementia patients, in terms of change in (confidence in) diagnosis and patient management plan.
This prospective bi-center study included 211 patients suspected of early-onset dementia who visited a tertiary memory clinic. Patients were eligible with Mini Mental State Examination ≥ 18 and age at diagnosis ≤ 70 years and in whom the diagnostic confidence was <90% after routine diagnostic work-up. All patients underwent [F]flutemetamol PET, which was interpreted as amyloid-negative or amyloid-positive based on visual rating. Before and after disclosing the PET results, we assessed the diagnostic confidence (using a visual analog scale of 0-100%) and clinical diagnosis. The impact of [F]flutemetamol PET on the patient management plan was also evaluated.
[F]flutemetamol PET scans were positive in 133 out of 211 (63%) patients, of whom 110 out of 144 (76%) patients had a pre-PET Alzheimer's disease (AD) diagnosis and 23 out of 67 (34%) patients had a non-AD diagnosis. After disclosure of PET results, 41/211 (19%) diagnoses changed. Overall, diagnostic confidence increased from 69 ± 12% to 88 ± 15% after disclosing PET results (P < 0.001; in 87% of patients). In 79 (37%) patients, PET results led to a change in patient management and predominantly the initiation of AD medication when PET showed evidence for amyloid pathology.
[F]flutemetamol PET changed clinical diagnosis, increased overall diagnostic confidence, and altered the patient management plan. Our results suggest that amyloid PET may have added value over the standardized diagnostic work-up in early-onset dementia patients with uncertain clinical diagnosis. This study provides evidence for the recommendations put forward in the appropriate use criteria for amyloid PET in clinical practice.
Nederlands Trial Register NTR3743 . Registered 7 December 2012.
早发性痴呆患者常表现出非典型临床症状，妨碍准确的临床诊断。本研究的目的是评估淀粉样蛋白正电子发射断层扫描（PET）显像剂[F]氟替美莫对早发性痴呆患者诊断的影响，包括诊断（信心）的变化和患者管理计划。
这项前瞻性双中心研究纳入了211名疑似早发性痴呆的患者，他们就诊于一家三级记忆诊所。患者符合以下条件：简易精神状态检查表得分≥18分，诊断时年龄≤70岁，且在常规诊断检查后诊断信心<90%。所有患者均接受了[F]氟替美莫PET检查，根据视觉评分将其解释为淀粉样蛋白阴性或阳性。在公布PET结果前后，我们评估了诊断信心（使用0-100%的视觉模拟量表）和临床诊断。还评估了[F]氟替美莫PET对患者管理计划的影响。
211名患者中有133名（63%）的[F]氟替美莫PET扫描呈阳性，其中144名中有110名（76%）患者在PET检查前被诊断为阿尔茨海默病（AD），67名中有23名（34%）患者被诊断为非AD。公布PET结果后，211例中有41例（19%）诊断发生改变。总体而言，公布PET结果后诊断信心从69±12%提高到88±15%（P<0.001；87%的患者）。在79名（37%）患者中，PET结果导致患者管理发生改变，当PET显示有淀粉样蛋白病理证据时，主要是开始使用AD药物。
[F]氟替美莫PET改变了临床诊断，提高了总体诊断信心，并改变了患者管理计划。我们的结果表明，在临床诊断不确定的早发性痴呆患者中，淀粉样蛋白PET可能比标准化诊断检查更有价值。本研究为临床实践中淀粉样蛋白PET合理使用标准中提出的建议提供了证据。
荷兰试验注册NTR3743。2012年12月7日注册。
